The little triangle of gums between your front teeth. Did you ever notice it? Look closely. Between each tooth should be a little triangle of gum called a papillae.
That little tiny triangle of gum is of ultimate importance when having an implant in the front of the mouth.
When you smile big you probably see these triangles. When an implant is ideal it should have a triangle of gum on each side. If it does not, it may look funny. In fact, it may be missing all together leaving a black hole.
There are ways to regenerate these papilla but the best way is to
prevent them from receding. I go through an extensive work up to predict the outcome before surgery ever begins.
The health of your real teeth around the implants is of utmost importance. If the adjacent teeth have even slight bone loss, this could prevent the formation of the papilla or it may not be as big as it is suppose to be.
This triangle of gum should be discussed with you should you elect to have implants for the front teeth. It is especially important if there are multiple dental implants next to each other.
The following pictures show what I call cosmetic failures. I did NOT treat these patients. These are dental implants that do not have the papillae:
These pictures are samples of my work:
Although this little tiny triangle of gum may be insignificant to you now, it is of paramount importance to me. It makes all the difference!
Let me know if I can help avoid this problem!
No related posts.
Hello Dr Amin
I am a 22 yr old female. I have lost my 4 upper front teeth after an accident and plan on getting two implants with a bridge.
My problem is that my gum line is uneven, even though before the accident very little gum would show when I smile I still feel that it made a difference and I feel uncomfortable smiling now.
My dentist said that due to my gum being thin a gum graft may be unsuccessful. Pink porcelain over crowns was suggested.
I would be grateful if you can make any recommendations.
Regards
Hi Sara,
I know how you feel.
A gum graft will almost ALWAYS help thin gums but MAY not put the “triangle” back. Do you have any pictures of you in a full, big smile that you can email me?
That will really help me to give you a better idea. Do you live nearby?
Dr. Ramsey Amin
Hello Dr. Amin,
Thank you for your reply.
Unfortunately, I do not live nearby. I can definitely e-mail you pictures before and after the accident.
Can you please let me know on which e-mail I can send them.
In the upper right is an “Email Me” link.
Go ahead and send it to me there.
Dr. Amin
Excellent post on the issue. I have also seen very few people care about Triangle of Gums Between Teeth and Implants. Thanks for this nice concern.
Hello Dr Amin,
I just came back from my periodontist in tears because this is going to be an issue with my implants.
You see, I was born without my lateral incisors and as a result my adult cuspids grew-in in their places. So, 2 years ago, he referred me to an orthodontist. I had my primary incisors pulled and the braces have been moving the cuspids over about 6.5mm to make room to implant the lateral incisors.
Today he tells me that my teeth are triangular and my gum has flattened next to my central incisors and that my options are to graft the gum, pull my central incisors down (which will in turn pull “a bit” of gum down), or square off my central incisors.
I’ve finally stopped crying and don’t know what to do. I’m not too keen on them pulling my front teeth down as I fear this may create MORE problems.
I would be grateful if you can make any recommendations.
Thank you.
Hi Keyro,
Do you show your gums when you smile big?
Dear Doc.,
I just got done with my Orthodontic treatment. Now my teeth are nice and aligned, and my smile never looked better. The only problem is the small triangles between the teeth and gums. I find that this is the place where the food particles get stuck, etc. Also having these triangles filled would make my smile even better.
Is is possible? If Yes, what would be the costs involved as a rough ball park estimate?
Thanks,
Ro.
Hi Ro,
Are you an adult or a teen? Do you have any bone loss from gum disease even if it is slight?
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
Voted Best Dentist in Burbank -2006, 2008, 2010, 2011
http://www.burbankdentalimplants.com
Thanks for the reply Dr. Amin.
I’m 27. I’m not quite sure but I think I might have a slight bone loss.
I am curious to know your opinion.
Thanks.
Hi Ro,
If you have all of your teeth (no implants) then the slight bone loss is more than likely causing this. Often, veneers or bonding are used to fill the spaces if it is truly due to bone loss.
It would be best to get into the hands of someone in your area to evaluate and diagnose the problem then discuss treatment. Are you local to southern California?
Dr. Amin
I do have all my teeth. Sorry I live in Texas. I guess I will visit a dentist to see what options do I have.
Thanks for the advice.
Dear Dr.Armin
I have a question regarding your column. I had done my Orthodontic treatment for year and a half. I started to notice my papillae are missing about half a year. But I didn’t really care about them until recently. I am not sure when it started missing actually, maybe even before I’m done with the Orthodontic treatment? Could the treatment be the cause?
Right now I have few places of papillae missing, they’re not major yet. Noticeable if look closely. I am afraid that it’s going to get worse. Would it get better if I keep my teeth clean and healthy, or at least not getting worse?
Thanks for your comment in advance,
Hi Chatdanai,
The most likely scenario is you have some degree of pre-existing bone loss between youor teeth. The bone crest between each tooth supports the gum triangle. Now that the teeth have moved from being crooked, the black triangles show because the teeth don’t overlap.
Are you over 35 years old?
Ramsey A. Amin, D.D.S., D.A.B.O.I.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
UCLA and Western U. Dental School Faculty
Hi Dr.Amin
Thank you for your reply.
No I am about to turn 24 this year.
I am still thinking that it maybe the side-effect of my Orthodontic treatment. I am also having gum receding on my mandible. I am worrying that it’s going to cause sensitivity and so on.
Is it normal after Orthodontic treatment to have this problem? Do you have any suggestion on my case?
Thank you,
Speak to your dentist asap. Without seeing you, I cant tell you exactly what the issue is.
Sorry!!
Dr. Ramsey Amin